The human endosalpinx: anatomical three-dimensional study and reconstruction using confocal microtomography

Abstract

Purpose: To evaluate in three dimensions (3D) the human endosalpinx and reconstruct its surface along its different anatomical segments, without the injection or insertion of luminal contrasts, using confocal microtomography (micro-CT).

Material and methods: 15 fallopian tubes (FT) from 14 women in reproductive age from procedures for benign disease or sterilization were selected. The specimens were fixed in formalin and stained with Lugol solution. Micro-CT studies were conducted on the specimens using protocols adapted from biological studies, to acquire images to reconstruct in 3D the endosalpinx surface.

Results: From these specimens, 6 presented the intra-mural segment, 14 presented the isthmus and 15 presented the ampulla and fimbria segment of the FT. The specimen presented tissue definition, and contrast sufficient for FT endosalpinx morphological analysis and lumen definition. The intramural portion presented initially a mucosal projection toward the lumen, bending on its own axis, and increased numbers of projections towards the isthmic portion, where the projections become longer more numerous. The endosalpinx becomes more tortuous, the lumen diameter increases and the mucosal projections become more bulky in the ampullary portion, with the projections less present on the antimesenteric side. The infundibular portion is marked with the organized and predictable endosalpinx, the abdominal ostium is cleared demonstrated, with the reduction of the endosalpinx volume. The fimbria demonstrated a small relation between fringes and intratubal endosalpinx.

Conclusions: Microscopic anatomy of different segments of the human FT mucosa can be analyzed and reconstructed in 3D with histological correlation using micro-CT.

Keywords: anatomy; fallopian tubes; multislice computed tomography; three-dimensional imaging.

Figure 1

Fragment of the ampullary segment of the fallopian tube. A) Histological section prepared after micro-computed tomography (micro-CT) analysis. B) Three-dimensional reconstruction of the same segment based on micro-CT images

Figure 2

A) Three-dimensional reconstruction of the coronal plane of the interstitial segment near the tubal ostium (the arrow indicates the mucosal folds). B) Sagittal plane of the uterine segment of the fallopian tube near the tubal ostium. C) Sagittal plane of the fallopian tube. D) Three-dimensional reconstruction of the same segment. The mucosal folds increase in size and complexity

Figure 3

Three-dimensional reconstruction of the isthmus to ampulla transition. A) The mucosal folds taper abruptly and the tubal lumen becomes distended. B) Tortuosity increases unpredictably and the lumen increases in size and complexity. The arrows indicate the isthmus

Figure 4

Sections of the fallopian tube of the same ampullary segment. A) Mucosal layers with areas without folds. B) The asterisk shows the most conspicuous mucosal folds in the center of the lumen

Figure 5

Three-dimensional reconstruction of tubal mucosa. The arrow shows the mucosa in the region between the isthmus and ampulla. The asterisk marks the ampullary mucosa. Note the difference between the luminal caliber and the muscle layer thickness

Figure 6

Three-dimensional reconstruction of the fimbria and sectioned abdominal ostium. The fimbrial mucosa is exposed and becomes narrower in the tubal ostium. Mucosal folds are present until the margins of the organ (arrows)